A single regulator for financial and care quality

There should be a single regulator dealing with corporate governance, financial competence, viability and compliance with patient safety and quality standards for all trusts.

More powers to suspend or prosecute boards and individuals

A service incapable of meeting fundamental standards should not be permitted to continue. Breach should result in regulatory consequences, attributable to an organisation in the case of a system failure, and to individual accountability where individual professionals are responsible. Where serious harm or death has resulted to a patient as a result of a breach of the fundamental standards criminal liability should follow.

Duty of candour

Every healthcare organisation and everyone working for them must be honest, open and truthful in all their dealings with patients and the public, and organisational and personal interests must never be allowed to outweigh the duty to be honest, open and truthful.

The NHS constitution should be revised to reflect the changes recommended with regard to a duty of openness, transparency and candour, and all organisations should review their contracts of employment, policies and guidance to ensure that, where relevant, they expressly include and are consistent with the above principles and these recommendations.

Gagging clauses should be banned

Gagging clauses or non-disparagement clauses should be prohibited in the policies and contracts of all 22 healthcare organisations, regulators and commissioners; insofar as they seek, or appear, to limit bona fide disclosure in relation to public interest issues of patient safety and care.

Only registered people should care for patients

A registration system should be created under which no unregistered person should be permitted to provide direct physical care to patients currently under the care and treatment of a registered nurse or a registered doctor (or who are dependent on such care by reason of disability and/or infirmity) in a hospital or care home setting. The system should apply to healthcare support workers.

This approach is applicable to all patients but requires special attention for the elderly.

It should be clear who is in charge

Hospitals should review whether to reinstate the practice of identifying a senior clinician who is in charge of a patient's case, so that patients and their supporters are clear who is in overall charge of a patient's care.

A new role for the CQC

The secretary of state should consider transferring the functions of regulating governance of healthcare providers and the fitness of persons to be directors, governors or equivalent persons from Monitor to the Care Quality Commission (CQC).

Specialist inspectors

The CQC should develop a specialist cadre of inspectors by thorough training in the principles of hospital care.

Media reports

Those charged with oversight and regulatory roles in healthcare should monitor media reports about the organisations for which they have responsibility.

Directors should be 'fit and proper'

There should be a requirement that all directors of all bodies registered by the Care Quality Commission as well as Monitor for foundation trusts are, and remain, fit and proper persons for the role. Such a test should include a requirement to comply with a prescribed code of conduct for directors.

Complaints should be published on hospital websites

Subject to anonymisation, a summary of each upheld complaint relating to patient care, in terms agreed with the complainant, and the trust's response should be published on its website.

Role of GPs

GPs need to undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services.

Role of local Healthwatch

Local authorities should be required to pass over the centrally provided funds allocated to its local Healthwatch (the new "consumer champion" body for healthcare), while requiring the latter to account to it for its stewardship of the money.